By Deidre McPhillips and Kyla Russell
The Supreme Court decision that overturned the federal right to an abortion created a patchwork of laws across the United States and widespread uncertainty. Among those with questions are the nation’s future doctors.
Morgan Levy, a medical school student at the University of Miami, said the impacts of the ruling immediately became a point of discussion among her peers. She’ll be applying to residency training programs this fall, and now has to assess whether the new laws will affect what she’s taught and how.
“More than ever, I recognize the importance of good, comprehensive, evidence-based reproductive health care,” said Levy, who plans to train as an ob/gyn. In some states, though, it has become “all but impossible” to get formal family planning training, including abortion practices.
“There is definitely a consideration of making sure that the training programs that I’m applying to are going to be able to provide the kind of training that I’m going to need in order to be able to do that for my patients,” she said.
And new data suggests that these restrictions are having an impact on where — and what — future doctors plan to practice.
The number of medical school students who applied to residency training programs ticked down last year, and applications to programs in states with abortion bans dropped the most, according to a new analysis from the Association of American Medical Colleges.
Interest in the ob/gyn speciality took a notable dip, with applications dropping 5% nationwide and twice as much in states where abortion is banned. Emergency medicine also saw a significantly large drop in applications.
Despite the decline in applications, all ob/gyn residency positions and most others were filled. So while there’s no immediate shortage of physicians in-training, experts say the shift is reason for concern.
“I worry about exacerbating these maternal health care and abortion deserts that already exist. We already have a gap,” said Dr. Kristyn Brandi, an ob/gyn in New Jersey and chair of the board of directors for Physicians for Reproductive Health. “Because of that, we need more ob/gyns to join the field to help build up practice in places where we’re losing providers for other reasons.”
More than a third of US counties have limited or no access to maternity care, according to a recent report — and there’s notable overlap between maternity care deserts and states where abortion access is limited.
Most physicians stay in the area that they trained. If programs in states with abortion bans shift to less desirable training plans, more and more students could prioritize being in less restrictive states for residency — and eventually to practice.
Long-term, that could create a “tiered system of health care,” Brandi said.
However, experts say it will be important to track the preferences for medical school students in the years to come. Last year’s graduating class applied to residency programs just months after the Supreme Court’s ruling. They had to make decisions before seeing exactly how the programs would react and adjust.
“For the next year or two, things are gonna be really uncertain for people. And I think that many people didn’t want to engage in that uncertainty, not knowing what they were signing up for,” Brandi said.
For Levy and others, perhaps more important than the specific location of a program is evidence that there is a strong and well-established commitment to training around family planning.
“That’s really a green flag to me when programs have a really formal plan in place,” Levy said.
The Zucker School of Medicine at Hofstra/Northwell has long participated in the Ryan Residency Training Program that offers a specific focus on abortion and family planning.
Dr. Nagaraj Gabbur, who is the director of the ob/gyn residency program there, said that this specialized curriculum is usually one of the top reasons applicants give for why they want to practice there — and especially in the latest round of interviews.
For programs outside of “haven states” like New York, this could involve an out-of-state rotation.
But for Brandi, rotational programs are just a “Band-Aid” that don’t address the underlying issues challenging reproductive health care — and don’t consider the livelihood of the individual trainee.
Also, most of the physicians in the ob/gyn field are women. Even if certain training programs suffice, there might be personal concerns about living in states where abortion is banned, she says.
“This may impact not only the care that they want to provide as physicians, but also the care they can receive themselves,” Brandi said.
As Levy and her peers consider a major step forward for their lives and career, discussions on the topic are constant — and complicated.
“It’s not a black or white or red versus blue kind of issue,” Levy said.
There are a lot of mixed emotions as people weigh many different factors, including clinical interests, logistics of the role, personal preference for location and broader implications.
Some feel strongly that they should train in a state that has preserved access to abortion, while others, like Levy, feel that there may be opportunity for advocacy in more restrictive environments.
“It’s almost less so about the state itself and more so about the program’s attitudes and responses to the decision and the ways in which they’ve affirmed their commitment to making sure great care is provided in their states,” Levy said.
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